| NPI | 1770472821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 20515) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-BLAMRD) |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2026-03-30 |